A Complex Case of Acne and Chronic Rash in a Young Adult Female: Village Dermatology Katy & Houston Case Study
By: Dr. Caroline Vaughn
Patient Background
A 20-year-old female from the Houston area presented to Village Dermatology for evaluation and treatment of two persistent dermatological conditions: moderate acne and a chronic, itchy rash on the legs and trunk. She had been using over-the-counter acne products with little relief and was currently applying a topical antifungal cream for her rash without significant improvement.
Clinical Findings
On physical examination, she had:
Comedonal and inflammatory acne lesions across the face, arms, and trunk.
Scaly, erythematous rash patches on the thighs, trunk, and sternum—especially itchy on the chest.
Negative KOH prep for fungal elements, ruling out active tinea.
Her acne had been long-standing and resistant to standard topical treatments. Her rash, present for several months, appeared consistent with pityriasis rosea (PR) though other conditions such as contact dermatitis and nummular eczema were considered.
Diagnosis & Differentiation
Severe acne (L70.0): The presence of scarring and lack of response to OTC treatments led to the decision to initiate isotretinoin (Accutane) therapy.
Dermatitis (L30.9): Due to the non-specific nature and chronicity of the rash, the working diagnosis was dermatitis of unspecified cause, pending further response to treatment.
Treatment Plan
Acne:
Isotretinoin (Accutane) initiation at 40mg/day following iPledge compliance procedures.
Monthly lab monitoring (hepatic panel, triglycerides) and pregnancy tests.
Aviane oral contraceptive prescribed for dual contraception during isotretinoin therapy.
Thorough counseling on risks: dry skin, joint aches, photosensitivity, mood changes, and teratogenicity.
Dermatitis:
Triamcinolone 0.1% cream applied twice daily for two weeks.
Skin care instructions: regular moisturization, use of emollients, and avoiding application of steroids to the face and groin.
Follow-up in 1 month to assess response.
Patient Education & Compliance
Detailed counseling was provided:
The patient understood the long-term commitment and follow-up required for isotretinoin therapy.
Education on the importance of sunscreen use, gentle cleansers, and avoiding triggers for dermatitis was emphasized.
Follow-Up Plan
Monthly visits during isotretinoin therapy for acne management and monitoring.
1-month follow-up for reassessment of dermatitis response to triamcinolone.
Conclusion
This case highlights the importance of personalized dermatological care in managing complex skin conditions in young adults. At Village Dermatology, we provide expert acne treatment and rash evaluation in Katy and Houston, Texas, ensuring every patient receives tailored care that targets the root causes of their skin concerns.
